PURPOSE: Worldwide asthma prevalence is increasing. In Singapore, 1 in 20 adults suffer from asthma with about 108 deaths annually. There have been limited local studies on fatal and near-fatal asthmatic attacks. Hence a study was undertaken to determine the clinical characteristics of adults with fatal and near-fatal asthma. This would be useful in identifying asthmatics at risk of death.
METHODS: A retrospective study was conducted over a 5 year period from 2002 to 2006 at Changi General Hospital. Clinical characteristics of patients with asthma as a cause of death and patients with admission to the medical intensive care unit with a diagnosis of asthma were analyzed.
RESULTS: There were a total of 33 events of which 10 were fatal and 23 were near-fatal events. There were 19 females and 14 males. The median age was 52 years old. The most number of events occurred in the age group of 50–59 years old. 55% of cases were Chinese, 30% Malays, 9% Indians and 6% of other ethnic origin. Patients with a longer history of asthma were at an increased risk. There was no seasonal trend noted. Slightly more than half of the patients were on steroid inhalers. Of these, a third was on high dose therapy, 1/3 on medium dose therapy and 1/3 on low dose therapy. A quarter of patients were reliant on home nebulizer treatment. Analysis of unscheduled hospital visits showed that about a third of patients had a recent admission to hospital and 18% had visits to the ED in the preceding 3 months for an asthmatic exacerbation. More than half had never smoked. A significant proportion (57.6%) had cardiovascular risk factors.
CONCLUSION: No single clinical characteristic is accurate enough to predict a fatal or near fatal asthmatic attack.
CLINICAL IMPLICATIONS: Evaluating a patient's risk for a severe asthmatic attack requires a comprehensive assessment of various epidemiologic fatal-asthma markers.
DISCLOSURE: Koh Jansen, No Financial Disclosure Information; No Product/Research Disclosure Information